title: Pulmonary embolism, myocardial infarction, and ischemic stroke in lung cancer patients: results from a longitudinal study.
abstract: OBJECTIVE
  In this cohort study, the rates of pulmonary embolism (PE), myocardial infarction (MI), and ischemic stroke (IS) before and after lung cancer (LC) diagnosis were compared to cancer-free controls.
  
  
  METHODS
  Patients with LC during 2000-2007 were selected from PALGA, the Dutch Pathology Registry, and linked to the PHARMO medical record linkage system, including drug use and hospitalizations of 3 million inhabitants in the Netherlands. Included LC patients were matched 1:10 by age and gender to cancer-free controls. Hospitalizations for PE, MI, and IS were assessed in the 12 months before and after LC diagnosis.
  
  
  RESULTS
  LC patients (N = 3,717) were six times more likely than cancer-free controls to have had a PE in the 12 months before diagnosis. After LC diagnosis, patients experienced an extremely increased risk of PE in the first 6 months (hazard ratio [HR] 16.8; 95 % confidence interval [CI] 7.6-36.8) compared with controls), which decreased to a five times increased risk (HR 5.1; 95 % CI 2.7-9.4) thereafter. However, there were less than two events per 100 person years during both time periods. LC patients receiving chemotherapy were eight times more likely to develop PE, whereas surgery increased the risk on PE three times. For MI and IS, no significant difference was observed compared with cancer-free controls before or after LC diagnosis.
  
  
  CONCLUSIONS
  LC patients have a higher risk of developing PE compared with cancer-free controls, although the frequency of PE hospitalizations was low. Surgery and chemotherapy were associated with an increased risk of PE.
authors.affiliation: PHARMO Institute for Drug Outcomes Research, P.O. Box 85222, 3508 AE, Utrecht, The Netherlands, myrthe.van.herk@pharmo.nl.
authors.forename: Myrthe P P
authors.initials: MP
authors.lastname: van Herk-Sukel
authors.forename: Sumitra
authors.initials: S
authors.lastname: Shantakumar
authors.forename: Fernie J A
authors.initials: FJ
authors.lastname: Penning-van Beest
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: Christof J
authors.initials: CJ
authors.lastname: Majoor
authors.forename: Lucy I H
authors.initials: LI
authors.lastname: Overbeek
authors.forename: Ron M C
authors.initials: RM
authors.lastname: Herings
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004358:Drug Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D011013:Pneumonectomy; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*